In Transition: Elizabeth Gatewood Envisions a Path Forward for Family Nurse Practitioner Education

September 2018Diana Austin

Family nurse practitioner (FNP) Elizabeth Gatewood wears a lot of hats. As associate clinical professor in the Department of Family Health Care Nursing, she teaches graduate-level nursing students at the UC San Francisco School of Nursing and has a clinical practice at the Family Health Center at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center. As the clinical placement coordinator for UCSF’s Family Nurse Practitioner program, she develops and oversees the community partnerships between the program and clinical sites around California that provide essential practical experience for future FNPs. She also coordinates a pair of grant-based projects aimed at preparing students to care for some of the state’s most underserved populations. Now, as the program’s new director, she’s responsible for steering it through a period of transition and growth.

Mental Health Care or Family Practice?

Gatewood began her college career aiming to become a mental health professional. After graduating from New York University with a degree in psychology, she worked with a mobile homeless outreach program that attempted to transition people living on the street to treatment programs or shelters. She realized she wanted to work more in-depth with this vulnerable population. She says, “I was driving around a 16-passenger van, picking up homeless people from under overpasses or burned-out buildings. After a while, I recognized that I was going to have to go back to school for the right career.”

Her original intention was to go into psychology or psychiatry, but fate intervened in the form of an FNP for whom Gatewood had been nannying. Gatewood remembers, “She said, ‘You should look into nursing because it really aligns with a lot of what you want to do. You could even be a psych NP and have your own practice.’”

She earned her BSN degree from NYU’s nursing school, thinking she’d eventually become a psychiatric/mental health NP. After working as a registered nurse in the intensive care and burn unit at NewYork-Presbyterian Hospital, and later helping human immunodeficiency virus (HIV) patients with medication adherence at Callen-Lorde Community Health Center, however, Gatewood realized that her interests included more than mental health nursing. So she moved across the country to enroll in UCSF’s Family Nurse Practitioner program, completing it, as well as the HIV Minor, in 2008.

After graduating from the program, Gatewood did a yearlong fellowship in Zambia, training clinical officers (similar to physician assistants in the U.S.) to start and manage patients on antiretroviral (ARV) medications, which were relatively new to the country. The challenge, she says, was to train clinical officers to look especially carefully at symptoms, because they had to manage patients without access to the lab work that helps guide clinicians in economically developed countries.

Back in the United States, Gatewood worked at Lyon-Martin Health Services, which provides health care to cis women, lesbians and transgender people, and at Dore Urgent Care Center, a diversion unit for people experiencing psychiatric emergencies that don’t require hospitalization. She later worked for the San Francisco Department of Public Health’s Medical Respite and Sobering Center, managing care for homeless patients discharged from the hospital but too ill to return to the street.

Through all of her work, she recognized the importance of caring for the body and the mind. Her work at Dore, Lyon-Martin and Medical Respite included mental health care. “If I didn’t do [mental health care], they didn’t get the care,” she says. “It forced me out of my comfort zone and made me recognize the intersection between mental health and primary care.”

Becoming an Educator

In 2009, while Gatewood was working at Lyon-Martin, Ellen Scarr, then professor of Family Health Care Nursing at UCSF, asked her if she would be interested in guest lecturing on transgender health. Those guest lectures turned into an invitation to precept students, then, in 2014, a suggestion that Gatewood apply to join the regular faculty at the School.

“I thought, ‘I don’t know if I’m qualified to do this,’” she says. Nevertheless, she jumped in.

As a faculty member, Gatewood was tapped to lead the Central Valley Clinical-Academic Remodel, known as CV-CARE, a project funded by a grant from the federal Health Resources and Services Administration (HRSA). CV-CARE focused on expanding clinical partnerships and training preceptors in California’s Central Valley to better prepare clinicians to meet the challenges of serving a diverse population that includes farmworkers, migrants and others with what can be complex health needs. Among Gatewood’s tasks were revising the curriculum, designing and implementing training for preceptors that included interprofessional learning, and incorporating simulation-based training into the program.

CV-CARE has nearly completed its three-year run, and successes and lessons learned from it inform another project with which Gatewood is involved. The Rural Health Advanced Practice Training (RHAPT) project aims to relieve health professional shortages in California’s rural areas by training advanced practice nurses to work in rural settings. The project, also supported by an HRSA grant, has blossomed into a Rural Health Minor, available to NP students at the School. Gatewood develops and implements trainings and tools to support preceptors with rural practices in their teaching.

Supporting clinical preceptors has become a passion for Gatewood. “I really want to grow and expand on the tools and support we give preceptors. A lot of them are doing this as part of paying back to their profession, and they have such a wealth of knowledge and expertise. I want to support them in being able to be creative in their education and their strategies,” she says.

A Program in Transition

Support and opportunity are Gatewood’s watchwords for the FNP program.

The program is in transition, she notes, with this year’s retirements of RHAPT project Director and FNP program Director Erica Monasterio and Pilar Bernal De Pheils, director of the Young Women’s Clinic. “They were pillars of the FNP program, so it’s a big transition but also an exciting time,” says Gatewood. “We have a lot of wonderful new faculty who are really starting to engage in changing the courses. It’s a great opportunity for us to really look at our program and our students’ experiences.”

Gatewood’s primary goal, she says, is to maximize faculty satisfaction and foster their professional growth. Her experiences at Duke University School of Nursing, where she recently completed her doctor of nursing practice degree, have given her ideas for providing more resources for faculty: “Everything from exam blueprints, ways to flip the classroom, how to be more effective in preparing students to read the assignments, and thinking about competency- versus time-based teaching,” she says.

She allows that the challenges are significant.

“Some of our courses get handed down year after year, so we need to take a fresh look at our curriculum and how we’re offering it,” she says. “We have a new generation of learners, and they’re very different from previous generations. We need to be creative in the way we’re educating them and make sure we’re really testing their clinical reasoning and knowledge.”

English as a second language (ESL) learners are a case in point, Gatewood notes. With more students from non-English-speaking backgrounds coming in, she says, faculty need to look at how test questions are structured to ensure learners are being tested on their knowledge of the material rather than their ability to use formal written English.

To make sure the changes are sensitive to student needs, FNP faculty members are considering using design thinking – a creative approach to problem-solving that borrows from the processes designers use to understand and serve users – in the program to gain student perspectives from the time they apply to the School through completion of the program, to see how they interact with faculty and examine their experiences of UCSF and the FNP program. The hope is that such a project would enable the faculty to glean insights into how to better serve students throughout their journey. Gatewood is looking at potential partnerships with schools that teach design-thinking skills to integrate them into the School’s curriculum and coursework.

Empowering Faculty to Make Changes

Empowering faculty to try new approaches is a key part of Gatewood’s strategy. “I think that giving them permission to change things up is the first thing, and letting them know it doesn’t have to be perfect the first time,” she says. She mentions her own symptom management class as an example. “This will be my fifth year teaching it, and I change it every year. There are some things that work well and some that don’t, and I change it back. It’s a fluid process, and I know that every class is going to be a little different.”

Other goals include raising the profile of the FNP program and helping faculty achieve the life-work balance that seems to elude many dedicated professionals. “My vitamin D levels are probably lower than they should be,” she says ruefully. Nevertheless, she finds time to go trail running with her dogs and to sail the bay with her partner. “You have to have some balance,” she says, and she hopes to encourage other faculty to find it.

The endgame of empowering faculty is, of course, to educate a well-rounded, competent and compassionate workforce of FNPs for the future.

Gatewood says, “It’s an exciting time for our program, where we can take a fresh look at things and how we can better prepare our learners, because, in the end, they are going to be taking care of the patients.”